As a medical professional in the vibrant city of Chicago, providing quality healthcare services to patients is undoubtedly your top priority. However, staying well-versed in the ever-evolving landscape of compliance and regulations is essential alongside the noble pursuit of healing. Understanding and adhering to the legal requirements specific to the healthcare industry in Chicago is crucial to ensuring the well-being of your practice and your patients.
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The healthcare industry is one of the country’s most regulated markets, making medical compliance a vital and expanding field. Some neighborhoods of Chicago are recognized by the state, federal, and commercial dealers as hotbeds for non-compliant healthcare services and transactions. These organizations operate an unsustainable business model that greatly risks the lives of their patients. However, non-compliance can sometimes occur due to procedural issues or paperwork errors.
This blog broadly covers the key legislation that all practitioners should know and the potential consequences of default. Whether you are a seasoned practitioner or just starting your medical journey, this guide aims to equip you with the knowledge to navigate the complex world of healthcare compliance confidently. If your organization requires more clarity on healthcare compliance, contact attorneys specializing in this domain via this website. They can help guide you through the nuances of the law and pitfalls to avoid.
What is Healthcare Compliance?
Healthcare compliance refers to state and federal regulations that dictate privacy and usage guides for patient data, ensure superb patient care, prevent malpractice, and protect healthcare workers.
It encompasses a system of policies, training, and processes that adhere to government healthcare laws. All Medicare/Medicaid providers, equipment suppliers, and commercial healthcare insurers must provide high-quality services as expected from an average person or entity in the same position.
Some of the most well-known acts, regulations, and laws that healthcare providers need to observe include:
Safeguarding Privacy
Privacy of patient data is a requirement of the Healthcare Information Portability and Accountability Act, aka HIPAA. The act requires healthcare providers to protect and handle patient medical data with care so they don’t end up in the hands of malicious persons and entities. The inspector general’s Office in the Department of Health and Human Services is the federal wing in charge of ensuring all health practitioners observe this law.
The HITECH Act, aka Health Information Technology for Economic and Clinical Health Act, encourages the standardization of patients’ electronic health records. The law directs the federal Health and Human Services (HHS) Office for Civil Rights to perform regular provider audits and penalize patient data breaches to $1.5 million.
Ensuring Quality Care
Regarding quality healthcare, the Emergency Medical Treatment and Labor Act, aka EMTALA, requires Medicare-affiliated facilities that provide emergency services to give medical examination and stabilizing care to patients needing emergency medical help regardless of insurance limit or economic level.
Furthermore, the 2010 Affordable Care Act brought essential, subsidized healthcare to Americans. It required healthcare practitioners to dovetail patient care services within a network of physicians and hospitals to keep costs low and improve quality of services.
Penalties and Potential Consequences of Healthcare Non-Compliance
In Chicago, healthcare organizations that fail to comply with the relevant regulations and requirements can face various penalties and consequences. It’s important to note that specific penalties may vary depending on the nature and severity of the non-compliance. Regulatory bodies, such as the Illinois Department of Public Health (IDPH) or the Office for Civil Rights (OCR), can impose monetary penalties on non-compliant healthcare organizations.
Further, individuals and organizations may face license suspension or revocation for serious and repeated violations. This penalty can result in the temporary or permanent closure of the facility or the blacklisting of practitioners. Non-compliant organizations may be excluded from participating in government healthcare programs like Medicare or Medicaid. This exclusion can severely impact the organization’s ability to provide care and receive reimbursement for services rendered to program beneficiaries.
Patients or other affected parties will likely file lawsuits seeking damages resulting from non-compliance, privacy breaches, medical negligence, or other violations. This will have a direct fiscal impact on the organization.
Negative publicity, loss of patient trust, and damage to the organization’s brand can have long-lasting effects on its viability and success. Regulatory bodies may require non-compliant organizations to implement corrective action plans, which involve addressing the identified violations, implementing necessary changes, and demonstrating ongoing compliance.
Government agencies have recently started pursuing and bringing charges against fraudulent and non-compliant healthcare providers. For example, a local healthcare technology outfit was recently discovered to be involved in a billion-dollar fraud scheme leading to the prosecution and charging of two ex-employees and four executives.
In another landmark case,charges were successfully brought upon four women for defrauding the state Child Care Assistance Program of a million dollars in fraudulent claims.
Some of the penalties for non-compliant practices include:
- Criminal arraignment
- Revocation or suspension of medical license
- Monetary fines
- Exclusion from state Medicaid projects
- Termination of hospital privileges
- Denial of federal contracts
How a Chicago Healthcare Compliance Lawyer Help
Attorneys with practice in healthcare compliance laws and regulations can help you set up a proper compliance program for your practice. A genuine compliance program protects your staff and practice from civil, criminal, and administrative penalties from the state and federal government. It also protects your practice from payment scrutiny and banishment from healthcare provider networks.
A good attorney will work with your practice to establish or update your healthcare compliance solutions and train the staff to ensure compliant practices. When staff knows what is reasonably expected from someone in their position, they can work to reduce or prevent billing mistakes, fraudulent or erroneous claims, and transaction audits.
In case you get sued, an attorney will also provide representation. They will leverage their background in healthcare compliance laws, formulating solid defenses, and fighting for a better outcome.
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